CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Doctors Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $357
Cash Discount Price: $1,172
vs. Medicare Baseline: 2.63x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Doctors Hospital is $357. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,172. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 2.63x the Medicare baseline. Located in 3651 Wheeler Road, Augusta, GA.

Cash / Self-Pay

$1,172

Average discount available for prompt cash payment at this facility.

Insurance Median

$357

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$135.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.6 (100%)

Cash / Self-Pay: $1,172 (864%)

Insurance Median: $357 (263%)

Cash: $1,172 (864% of Medicare)

Ins. Median: $357 (263% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $135.6 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 263% of the Medicare baseline (a markup of 163%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Cigna	$144 - $454	106%
Amerigroup	$162 - $281	119%
Ambetter / Centene	$166 - $289	122%
Aetna	$171 - $1,092	126%
United	$178 - $891	131%
Friday Health	$194 - $337	143%
Absolute Total Care	$205 - $357	151%
Nhc Advantage	$216 - $376	159%
Pruitt Health	$216 - $376	159%
Peach State	$228 - $396	168%
Wellcare	$228 - $396	168%
Centurion	$315 - $549	232%
Medcost	$571 - $1,266	421%
Kaiser Permanente	$623 - $1,083	459%
Multiplan	$684 - $1,783	504%
Performax	$775 - $1,347	572%
First Health	$854 - $1,486	630%
Employer'S Health Network	$911 - $1,585	672%
Novanet	$1,025 - $1,783	756%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $1,172.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99214.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Doctors Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99214.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.